Student Information Form
2023-24
Student's Name
First Name
Last Name
Student's Date of Birth
-
Month
-
Day
Year
Date
Place of Birth
Gender
Please Select
Male
Female
Residential Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Corrospondent Address (fill up only if different from Residential Address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of last school
Medium of Instruction
Please Select
Online
Physical Assignments
Last school result
Promoted (passed)
Failed
Reason for leaving last school
Local Guardian Name
First Name
Last Name
Local Guardian Occupation
Local Guardian Email
example@example.com
Local Guardian Phone Number
Please enter a valid phone number.
Allergies
Medication
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Should be Empty: